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Good afternoon and welcome to the “Advancing the National Quality Strategy: An Introduction to the Stakeholder Toolkit” Webinar. We’re excited to have everyone on the phone and online today.
Agenda (Slide 2)
My name is Ann Gordon and I will be facilitating today’s event. Here’s the agenda for the call today. We’ll hear from Dr. Nancy Wilson, who’s going to give us an overview of the National Quality Strategy and insight into the Stakeholder Toolkit. The Toolkit is free and available for everybody to use to spread the National Quality Strategy. We will collect questions from you throughout the presentation for Dr. Wilson to answer during the Question and Answer session after the presentation.
How to Submit a Question through the Webinar Console (Slide 3)
Here’s an image for how to submit a question through the Webinar console. You can submit questions to us, and Dr. Wilson will be answering them at the end of the Webinar.
We’ll be posting the transcript and presentation slides to the Working for Quality Web site within 10 working days.
Overview of the National Quality Strategy (Slide 4)
I would now like to introduce Dr. Nancy Wilson, who serves as a Senior Advisor to the Director of the Agency for Healthcare Research and Quality. Dr. Wilson leads implementation of National Quality Strategy on behalf of the Department of Health and Human Services as directed by the Patient Protection and Affordable Care Act. Dr. Wilson has worked with stakeholders across the public and private sectors to engage in health care issues.
Background on the National Quality Strategy (Slide 5)
Dr. Wilson: Thanks Ann, and welcome everybody.
The National Quality Strategy is a centerpiece of the Patient Protection and Affordable Care Act. The challenge given to us by the Act was to create a national strategy for quality improvement that would improve the delivery of health care services, patient health outcomes, and population health; no small task, I might add. The Strategy is for the nation and is nationwide; it’s not a Federal or a government strategy. We hope it will be a catalyst and compass for a nationwide focus on quality improvement.
The Strategy has been iteratively designed by public and private stakeholders and I see it as an opportunity to align quality improvement and monitoring of impact efforts. To date the primary groups involved include the Department of Health and Human Services, a government-wide working group on health care quality, and two groups convened by the National Quality Forum: the National Priorities Partnership and the Measures Application Partnership.
As you can see, a wide range of stakeholders came together to develop the Strategy. That’s why I’m so excited you all have joined. If we’re going to achieve nationwide alignment to the National Quality Strategy and focus our efforts we really need the commitment and engagement of stakeholders at the State and local level on the frontlines because as we know, all health care is local.
National Quality Strategy Three-Part Aim (Slide 6)
So what is the Strategy? The Strategy is to concurrently go after better care, healthy people/healthy communities, and affordable care.
The Triple Aim and the Three Aims (Slide 7)
For those of you familiar with the Institute of Healthcare Improvement this may sound familiar, and it should. The National Quality Strategy builds on over ten years of work the Institute of Healthcare Improvement has done in working with the Triple Aim. How we build on that is to emphasize the health of all peoples in geopolitical communities and the affordability of health care for multiple groups, including families who are paying extremely high premiums and high deductibles, and employers whose products have been going up in price because of the increased cost of employee benefits. These considerations are addressed by the Strategy, in addition to concerns regarding the per capita cost of health care, which is an indication of what we’re paying as a society.
Hopefully these aims make sense to you and resonate with you, but I think you’d agree they’re pretty broad. To better focus our efforts on critical priorities we see driving improvement in this country, we chose six priorities.
National Quality Strategy Aims and Priorities (Slide 8)
The improvement priorities are patient safety, person- and family-centered care, effective communication and care coordination, prevention and treatment of the leading causes of mortality, health and well-being, and making quality care affordable.
Whether a stakeholder’s organization focuses on one priority or aligns their entire strategic plan to all six priorities, we believe any concerted effort to align is important and impactful for improvement.
Patient Safety Priority (Slide 9)
To drill down a bit further, I’d like to walk through how we think about one particular priority: patient safety. We believe that there are opportunities in patient safety that advance all three aims.
Patient Safety Priority’s Long-Term Goals (Slide 10)
How can we do that? By focusing on three specific long term goals. The long term goals, which we embraced from the recommendations of the National Priorities Partnership, are to reduce preventable hospital admissions and readmissions, reduce the incidence of adverse health care-associated conditions, and reduce harm from inappropriate or unnecessary care.
Patient Safety Priority’s Key Starter Measures (Slide 11)
So how can we track progress? By establishing quantitative targets and tracking our performance over time, basic “Quality Improvement 101.” For those familiar with the Partnership for Patients initiative, these should look familiar. It’s purposeful: we have patient safety as the priority, broad long term goals, more specific aspirational targets, and key metrics for monitoring our performance in coordination with a sponsored, nationwide quality improvement initiative. Similarly, for each of the additional five priorities, we’ve adopted long term goals, targets, and tracking measures. All of that can be found on the Working for Quality Web site.
What’s in the future for the National Quality Strategy? (Slide 12)
What’s in the future? The original Strategy was published in 2011, and the first Annual Progress Report to Congress was released in 2012. Soon we will be releasing the 2013 Annual Progress Report.
That’s going to give us an update on collaboration between public and private payers to align measures and reduce reporting burden on providers, which we have been hearing from the field is a huge issue. In fact, inside the Department of Health and Human Services we initiated a department–wide Measurement Policy Council with the goal of identifying a core set of measures that matter and minimize burden. So in addition to aligning public and private payers, we’ve been working inside the department towards measure harmonization.
The Annual Report also provides updates on the nation’s progress on key tracking measures, examples of private sector successes in quality improvement, and an update on progress within each of the three cross-cutting strategic opportunities for improvement identified by the National Priorities Partnership. For those of you curious about what those cross-cutting strategic opportunities are, they are really about developing a national strategy for data collecting, developing community based infrastructure for quality improvement, and further extending payment and delivery system reforms that emphasize primary care.
Tools and Resources: Priorities in Action (Slide 13)
That’s a very quick overview of the National Quality Strategy and a preview of some of the activities coming in the future. Now I’d like to highlight some tools and resources available. The Working for Quality website features Priorities in Action. These are some of the nation’s most promising and transformative quality improvement programs, and we describe the programs’ alignment to the National Quality Strategy. We feature one per month. We hope you’ll be able to use this information to learn about how others are doing great work. And of course we hope to learn what you’re doing to advance health and health care for the nation.
But the power of National Quality Strategy can only be realized by the network that supports it, the commitment of stakeholders at every level. Stakeholder engagement begins simply by getting the word out, striving to achieve a ubiquitous understanding of the Strategy and what it entails. We realize we’ve not gotten the word out and that’s what we’re trying to do now. To that end we’ve created a Stakeholder Engagement Toolkit for you to use. The Toolkit makes it easy to insert details about the National Quality Strategy into your existing communications and outreach efforts.
Tools and Resources: Stakeholder Toolkit (Slide 14)
Whether you’re just learning about the Strategy or are a veteran partner, you can support the Strategy’s implementation by helping us spread the word. The Toolkit contains downloadable materials to increase awareness about the Strategy and communicate its impact.
Contents of Stakeholder Engagement Toolkit (Slide 15)
I think we’ve all figured out that in today’s world one of the most effective ways to get the message out to stakeholders is through the Internet and social media. Organizations are constantly looking for content to share with their target audiences and we want to help with that. The Fact Sheets give a comprehensive glimpse at the Strategy and all its pieces. The Toolkit also includes two different blog entries, one providing an introduction to the Strategy and the other detailing five important facts about the Strategy and its impact.
For those stakeholders that have Twitter and Facebook feeds, the Toolkit also includes several social media announcements with links to the Working for Quality Web site. We're hoping that this will encourage any stakeholder, all of you included, to post or tweet a quick link to the National Quality Strategy and help to spread an understanding of the Strategy to your audiences.
Tools and Resources: Briefing Slides (Slide 16)
We also have Briefing Slides available on the Working for Quality Web site that provide a substantial introduction to any one unfamiliar with the Strategy. So they provide more background, each of the priorities is described with their corresponding long term goals and key starter measures. We also provide illustrative examples that we see stimulating quality improvement for each of the priorities. The Briefing Slides are available for download and use, whether you download the whole PowerPoint or cut out one or two slides to add to your own presentation.
How to Find These Tools and Resources (Slide 17)
So, what's next? The Working for Quality Web site contains a range of materials for learning more about the Strategy and efforts supporting its implementation. Help us strengthen our network by exploring the tools, and sharing the National Quality Strategy with others. To make it easy for you, your browser will be automatically directed to the Working for Quality Web site immediately following this Webinar, and we encourage you to use what the site has to offer. Please provide feedback on the usefulness of the content as well as the questions and issues that your audiences raise. I'm happy to chat at any time and will really appreciate your advice and ongoing guidance as we move forward on this journey. With that I will turn it back over to Ann for our Question and Answer session.
Question and Answer Session
Ann Gordon: Thank you very much. For those who may not have been able to get the slides, please contact us and we will send those to you. But do know that a copy of the slides from this presentation as well as a transcript of today's event will be posted to the Working for Quality site.
Question 1 (Ann Gordon): When do you anticipate the 2013 National Quality Strategy Annual Progress Report to Congress will be released?
Dr. Wilson: The 2013 National Quality Strategy Annual Progress Report is currently undergoing Department of Health and Human Services clearance. We're hoping to release it by the end of June.
Question 2 (Ann Gordon): We have a question asking for us to name the six priorities again. So we will navigate back to Slide 8 “National Quality Strategy Aims and Priorities,” and have you run through those again.
Dr. Wilson: The first is patient safety; the second is person- and family- centered care; the third is effective communication and care coordination; the fourth is prevention and treatment of the leading causes of mortality, starting with cardiovascular disease; the fifth is health and well-being; and the sixth is making quality care affordable.
I know that the last two priorities—"health and well-being" and "making quality care affordable"—are also aims. We really felt that the additional emphasis on moving beyond health care and making the link between health of people within a community and health care was necessary. There have been recent studies supported by the Institute of Medicine showing that if we really want to bend the cost curve on health care that we have to address the social determinants of health. We need to care for the "pre-patient" -- people in communities before they ever cross the door into health care.
Ann Gordon: If you are interested in learning about the long term goals and starter measures for each of the priorities, we ran through the patient safety priority during this presentation but all of them are contained in the Briefing Slides in the Stakeholder Toolkit. So if you navigate to the Working for Quality Web Site, click on the Toolkit button, you'll see two files listed -- one of them is the set of Briefing Slides and they go into greater depth on the priorities, the long term goals, and the starter measures.
Question 3 (Ann Gordon): Our next question is around measures that matter. You spoke earlier about a Federal group focusing on measurement. Could you go into greater detail on what that group is focused on accomplishing?
Dr. Wilson: We created this group a year ago now to align the measures that are used in various agencies inside HHS to monitor programs and providers participating in various programs. What we found is that frequently we'd measure the same construct, such as blood pressure control, in many different ways with very small differences in the how the measures were defined. So if you look across the Department of Health and Human Services at what the Indian Health Service is using, versus what Health Resources and Services Administration is using for their community health centers, versus what the Centers for Medicare and Medicaid Services is using, there were slight differences. So our initial focus was to identify for any given construct or concept (like blood pressure control) the laundry list of measures used across multiple programs and to come to consensus on using the same measures, preferably a National Quality Forum-endorsed measure. We worked over the course of the last calendar year to align around smoking cessation, hypertension, depression, hospital acquired infections, patient experience, and care coordination. We began working around the e-specification of care coordination measures, but I have to say we have a lot more work to do. We also looked for opportunities to simplify across the various agencies the implementation of Consumer Assessment of Health Providers and Systems surveys.
So those were our initial forays. But we as a group, the senior leaders across all the agencies within HHS, agreed that there is much more to getting to measures that matter than simply retrospectively aligning measures. We really need to be thinking in a coordinated fashion what are the priorities for filling gaps, how do we retire measures, how do we fund measure development across the department so that we are not duplicating effort, and how do we make sure we're being the best stewards of taxpayer dollars.
So that's work that we're moving into, in addition to now tackling perinatal measures. We're identifying opportunities to align and define a core set of measures for that particular topic.
Question 4 (Ann Gordon): Another question about the priorities. Can you say more about why you chose to use the word "person" rather than "patient" in Priority 2 (person- and family-centered care)?
Dr. Wilson: We have learned over the years that many people who engage with the health care system don't particularly view themselves as patients. The first example that comes to mind is folks with long-term disabilities. They may have health issues but tend to view themselves in a more holistic fashion. The term “patient”–and it may be a fad –gets a bit of a bad rap for reinforcing the power differential between the patient and the provider or clinician. So I think there's a growing consensus to emphasize person- and family- centered care. And it's also to emphasize a role for us as health care providers to begin to think, again, beyond the boundaries of what we typically define as the health care delivery system and think about how we support people staying healthy and not becoming patients in the first place. So it pushes us outside the box of only dealing with people who enter the door.
I'm a primary care doctor by training and I remember I was at the University of Michigan at M–Care HMO and I was assigned three thousand patients to my panel. I didn't see three thousand patients in the three years I was out there. I started to really worry about the people who never came into the clinic. I was seeing a small subset of the population, yet I was being asked to be responsible for the health of that population. I realized that if I was going to do that I needed to be thinking differently about my role, and who I could partner and engage with in a more effective fashion.
Question 5: Our next question is a request to review some content from earlier in the presentation. Can you review Slide 7 “The Triple Aim and the Three Aims” again?
Dr. Wilson: Sure. Don Berwick and colleagues coined the phrase the "Triple Aim" at least ten years ago. It really provides a fabulous focus on the Patient Experience, including the quality of care; Improving the Health of Populations; and on Reducing the Per Person Annual Cost of Health Care. We saw that as a great foundation for the National Quality Strategy, and in fact, Don Berwick was acting head of Centers for Medicare and Medicaid Services at the time we were developing the initial Strategy in 2010. He was working as part of our group on identifying the aims and priorities we should pursue.
So I think the National Quality Strategy "Better Care" aim is very analogous to the Institute of Health Care Improvement "Improving the Patient Experience of Care" aim. I've learned in discussions with folks the phrase "health of populations," which means a lot of different things to different people. For some of my colleagues in primary care, it refers to the health of the panel of people that they are responsible for -- as I was describing to you earlier in my own experience at the University of Michigan.
Here we wanted to emphasize that it is about helping people be healthy and addressing the social determinants of health, but it's also about looking at the environmental determinants of health. These are things like access to food markets and fresh foods. If we have nothing in the vending machines in our school systems, how do we expect to even begin to tackle the childhood obesity issues? It's looking not only at individual's responsibility and support for individual behavioral determinants of health, but also considering how can communities support the health of the people that live in those communities. Studies have shown that health care only contributes 9 percent to the health of the population and I remember having finished nursing school, medical school, residency, and I read that study and I said, "Really?" Those studies have been repeated and push the impact of health care on the health of population to about 20 percent. That means there are a whole lot of other things we have to think about to help people stay healthy. Whether all those items are part of a broader health care system or not, I think it behooves us who are passionate about helping people to think about the broader opportunities. The other reason this is part of the National Quality Strategy is because our challenge, our mandate from the Affordable Care Act was to improve the delivery system, improve health outcomes, and improve population health. It challenged us to the think beyond the 20 percent influence from the traditional delivery system.
Question 6 (Ann Gordon): No more questions in the inbox, but we're asking a question on behalf of State health departments who are curious about how they can adopt the National Quality Strategy for their particular organization?
Dr. Wilson: I think it gets back to a comment I made earlier that the strength of the Strategy is really based on the strength of the network that embraces and supports the network. I would say it would be great to go on the Working for Quality Web site, browse our resources, tee up the three aims and six priorities with your constituents, and see how it resonates. Then provide that feedback and share the issues and questions you're asked, because we would certainly love to help design content and further design the Strategy with your input involved.
I think that we also will be featuring how one State has embraced the National Quality Strategy and worked that into a State strategy. With the Priorities in Action we've been identifying initiatives at the local, State, Federal level, both public and private; we've been trying to capture a broad array of initiatives to post on the Web site for you all to see and perhaps adapt to your situation.
Ann Gordon: We have no further questions. Any parting remarks Dr. Wilson before wrapping up today's event?
Dr. Wilson: I've seen the list of registrants and I really want to thank you for joining us and let you know we know we can't do this without you. Email me any time with questions or comments.
Ann Gordon: Thank you everyone for taking time to join us this afternoon. Look for an email from us in the coming days directing you to the archive of today's event. We also invite you to sign up for updates from the Working for Quality Web site. We'll let you know as soon as the 2013 Annual Progress report is released. We plan on doing another Webinar as soon as it released and allow you to walk through the report and ask any questions you may have. Thank you very much.
Dr. Wilson: Thanks everybody!